The�Brachial Plexus�is a nerve network derived from the spinal cord that conduct signals to the shoulder, arm, and hand and controls their movement and sensation. Brachial plexus injuries are nerve injuries in which the nerves and/or the nerve roots of the brachial plexus are damaged. This injury affects the motor and sometimes also sensory functions in the patient’s arm and/or hand. Depending on the severity and extent of the injury the first symptoms may vary individually.

The nerves that make up the brachial plexus originate from the spinal cord and correspond to four cervical vertebrae and one thoracic vertebra.

Some patients have good or moderate use of their fingers, but little or no control over the muscles of shoulder and elbow. Certain others can use their arm, but�have little or no control of the fingers. Some patients have a completely flaccid limb with no sensory or motor functions.

The injury can also be bilateral in which case both arms are affected. The purpose of nerve surgery is to improve the functions of the arm. Nerve surgery is most effective when it is done between the ages of 5 and 12 months. After children turn 1 years old, the surgery may not be as successful, but surgery can still help children over 5 years of age that have still not recovered from this injury.

For some children,�neurosurgery�is not recommended or is not successful. In these instances, other procedures can be done to transfer muscles and tendons. This surgery is done by a plastic surgeon when the child is older and gives better use of the arm. After the surgery, children are usually in the hospital for two days. Four weeks after surgery you can begin doing the exercises again at home.

Diagnosis

The injury is diagnosed using MRIs, CT scans and an electro-diagnostic test known as�EMG�to assess nerve function and is commonly used in the evaluation of brachial plexus injuries. This helps in determining the extent and the location of the injury.

Symptoms

Symptoms include numbness, weakness in the muscles in the shoulder, arm, and hand, along with a burning sensation. Patients with a severe avulsion injury may also have a drooping eyelid, a phenomenon known as�Horner’s Syndrome.

The common injuries are:

• Neurapraxia: a condition where the nerve is stretched
• Neuroma: a condition in which scar tissue has grown around a disrupted nerve
• Rupture: one or more nerves are torn, but not at the spinal cord
• Avulsion: the roots of the nerves are torn away from the spinal cord. Multiple root avulsion is the most common diagnosis in high-energy traumatic brachial plexus injuries, such as occurs in a motorcycle or off-road vehicle accident.

The nerves are carefully examined and their functions are checked. Any scar tissue (neuroma) around the injury is removed. The nerve conduction and functions are checked again. In certain cases nerve grafts have to be used and these are harvested and transplanted from the back of the leg called the sural nerve. The removal of the Sural nerve will not impair coordination or strength in that leg. After the surgery an immobilizer is put on the arm. It cannot move out more than 45 degrees because the injury needs time to heal. The wrap must be worn for four weeks for progress to occur.

Tests

The patient may have a�nerve conduction study�(EMG or electromyography test) prior to surgery.

The surgery will take anywhere from 4 to 12 hours. Hospital stay would be for a couple of days. The arm will be in a sling and wrapped in an Ace bandage to restrict movement. This helps manage the pain as well. Hospital stay will be for a couple of days. One may notice some improvement within 4 weeks. A nerve graft will usually show results within 6 months. Some progress and improvement may continue for almost two years.

For some, Brachial Plexus Surgery is the best way to regain nerve control.

The other Neurology Procedures are:

Brain Surgery
Laminoplasty
Cranioplasty�� etc

Few Major Hospitals for Brachial Plexus Surgery are:

• Wockhardt Hospitals
  
• Apollo Hospitals
  
• Max Healthcare
  
• Piyavate Hospital
  
• Florence Nightingale Hospital
  

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